The objective of this proposal is to perform prospective longitudinal neuro-behavioral followup studies of children who sustained either accidental or non-accidental (e.g., physical abuse) traumatic brain injuries. To assess the influence of environmental factors on cognitive and behavioral outcomes, comparison groups of children who 1) sustained physical abuse with no brain injury and 2) normal controls will be evaluated.On the initial evaluation three months after injury, all three injury groups scored lower than controls on indices of general mental development and motor skills. The mental and motor scores of the inflicted and noninflicted brain injury groups were similar, indicating comparable decline in abilities. The physical abuse group with no history of brain injury also had scores well below expected levels. MRI data confirmed that 24% of the children in this group had evidence of pre- existing brain injury typically identified as mild generalized cerebral atrophy. Longitudinal followup of cognitive, motor, and behavioral development is needed to identify the impact of brain injury and adverse environmental conditions on development.